| NPI | 1538571641 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: TX 1256428) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: VA 2305208678) |
| Enumeration Date | 2014-05-22 |
| Last Update Date | 2020-02-11 |